This blog is totally independent, unpaid and has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.

Wednesday, August 31, 2011

A Range of Perspectives On Personal Health Records (PHRs). Views From The UK and The US.

There has been continuing discussion this week on just what the right approach to patient empowerments with PHRs is.

Yet another review is being carried out into the viability of the HealthSpace organiser, which gives patients access to their Summary Care Record if it exists and they have an ‘advanced’ account.

Figures obtained by eHealth Insider show that the number of people using the NHS service to access their SCR has fallen by more than 50% since the beginning of the year.

In February, 60 patients a month were using an advanced HealthSpace account to see their record, but this has now fallen to just 25 a month.

A DH spokesperson told EHI the low usage was due to the site’s limited functionality and the lengthy registration process for an advanced account, which was introduced because of security concerns.

She also said: “The business case to enhance HealthSpace is under review in the context of efforts to make it easier for patients and citizens to easily and securely access services that meet their needs.”

Last week, the Cabinet Office launched an Open Data consultation on making government and public services information more ‘transparent’ to the public.

It once again presented wider online access to medical records as a key element in the government’s plans, claiming that this would “enable service design and delivery to be changed radically, reducing cost and improving quality.”

Free standing personal health records have failed to live up to the claims made for them; but other models are starting to have an impact in the UK. Shanna Crispin reports.

17 August 2011

A couple of years ago, there was significant hype about IT putting patients “in charge” of their own health by giving them control of their health records.

The talk sounded strange, given that patients have been able to jot down appointments and other notes about their health since the invention of pen and paper. It wasn’t clear what using an online space, store, or vault was supposed to add.

So it doesn’t seem surprising that some of the early personal health record products have fallen by the wayside. Google announced earlier this summer that it was pulling the plug on Google Health, due to a lack of public demand.

The service was launched in 2008 and allowed users to input data from their own at home devices, simple food and exercise charts, or test results.

Announcing the service’s demise, a post on Google’s official blog said: “There has been adoption among certain groups of users like tech-savvy patients and their caregivers, and more recently fitness and wellness enthusiasts.

“But we haven’t found a way to translate that limited usage into widespread adoption in the daily health routines of millions of people.”

Tied in, tied down

Yet personal health records are working for some people with a specific use for them. For example, the Ki Fit unit produced by company Ki Performance has an online subscription service that allows people to purchase the package with an armband to monitor activity and sleep.

The information is then loaded onto an online PHR, which users can use track their health and progress. It’s mainly intended for the growing number of people aiming to lose weight and mirrors similar online services, such as those offered by Jenny Craig and Weight Watchers.

Those looking to get seriously fit are another big market, with a number of companies offering services similar to the Nike+ running tracker.

On the medical front, Peter Singleton, director of Cambridge Health Informatics and principal research fellow at University College London, says that for a PHR to be successful, it needs to provide a link between patients and their clinicians.

In the US, this has led to the development of the ‘integrated’ PHR model – where users can enter data and share it with their clinician, and vice-versa – and the ‘tethered’ model – in which a PHR is linked to a particular institution of service.

Examples include My HealtheVet for war veterans. Users can input their personal information, activity and order medication. Clinicians are also able to access the account with approval from users.

In the civilian world, the Kaiser Permanente My Health Manager allows users to e-mail physicians, order prescriptions, view test results and make appointments, as well as view their records. And the Cleveland Clinic offers My Chart, where users can also book appointments and see lab results from the clinic when they are available.

Professor Don Detmer from the department of health sciences at the University of Virginia told eHealth Insider in an email these models are a “real breakthrough” and could turn out to be the “killer application” like Google’s role in the search engine world.

“Clearly, with ageing populations plus more chronic illness [and] more sophisticated care regimens for cancer and so on, having this kind of way to keep the patient at the centre of their care is very exciting.”

It’s a chicken-or-egg question: Will doctors adopting EHRs lead to a rise in the use of Personal Health Records (PHRs), or will increasing consumer demand for personal health information force reluctant doctors to go digital?

We’ve been inclined to believe that, over time, consumer demand will be the key to the HIT transition, but some experts seem to think it’s the other way around.

As this article puts it, policymakers and HIT observers note the slow rise in PHR use, but they suggest the reason is that, for one thing, patient information is still available only in fragmented form.

In the eyes of one HHS official, patients "can't easily get their information in an electronic form to flow into" a PHR. "If they're trying to use a stand-alone product and type it in all by hand, that's tough. When it becomes ... easy to download their information, I foresee interest in that area growing."

We don’t doubt there is probably some validity to this expectation, but it does smack a bit of a “field of dreams” approach to the HIT transition.

A lack of electronic medical data from doctors, complicated setup processes and the static nature of personal health records (PHRs) have caused U.S. consumers to shun the products. But PHR use should increase as more doctors use electronic health records (EHRs) and tech vendors develop offerings that are easier to use.

PHR use "is not incredibly high, but it is growing," said Lygeia Ricciardi, senior policy advisor for consumer e-health at the U.S. Department of Health and Humans Services. She cited a 2011 study from consulting firm Deloitte that found usage stands at 11 percent, a 3 percent increase from the 2008 survey.

Consumers interested in PHRs face compartmentalized offerings with enterprise IT vendors looking to unite the silos, said Liz Boehm, principal analyst, customer experience for health care and life sciences, at Forrester Research.

Entities that pay a person's health care claims, such as a health insurance provider, offer PHRs containing claim information, but lack clinical data like lab results, said Boehm. Doctors, using health care software from companies including GE and Epic Systems, can offer PHRs that include clinical data. These records prove "less useful," though, since they cannot link to a patient's pharmacy or another health care provider's system.

Microsoft's HealthVault PHR service, launched in 2007, attempts to bridge the gap between health care payer and provider systems, she said. HealthVault's objective is for doctors, pharmacies and other care providers to "feed their data into this record that is centered around the consumer."

Google also offered a PHR product, Google Health, but in June the company announced that it would end the service on Jan. 1, 2012. In a blog post, the company attributed its decision to Google Health's "limited usage."

Federal government mandates that require doctors to migrate to EHRs from paper-based systems will help solve the data issue, Ricciardi said. With "more providers coming online and with more access to digital information for consumers," she expects to see a "spillover effect" that will boost PHR adoption.

Linking EHRs to PHRs will "absolutely" increase PHR use, said Boehm. A doctor's involvement "fundamentally changes what the PHR is and what's being offered."

.....

However, a static PHR isn't "as compelling as file cabinet plus cool, interactive stuff," she said. People need a reason to access their PHR besides to add data.

"They want things they can do with their information," she said. "They want interactive applications, games, things that engage them in their health. There are more reasons to actually access and use your health information if more of these tools were out and about."

People need to see value in using a PHR and that proposition remains "pretty unclear," said Boehm.

"Labs results and prescription refills are the number-one and number-two reasons people go to their Kaiser PHR," she said, referencing the PHR offered by health care consortium Kaiser Permanente.

Tens of thousands of Cincinnati patients are experiencing firsthand the federal government’s push for higher health care quality as they get access to their health records online.

They’re logging in to perform such functions as getting test results, asking for prescription renewals and making appointments.

TriHealth Inc.officials said this week they’ve signed up more than 30,000 patients in their physician practices to MyChart since the launch a year ago of the patient portal software, made by Epic Systems Corp.

Consumers will engage with PHRs that provide channels of communication for them to and from their clinician especially if it will save them time and inconvenience to have simple health issues without the need to visit a surgery etc.

We would do much better in patient engagement if we developed systems with functionality that supported these sorts of activities. I recognise that there may be additional costs for the practitioners involved in setting up and operating such services and these costs and relevant time compensation should be offered if the Government is convinced such patient / provider interaction makes clinical and economic sense.

Just whipping up a registration screen for a national system that does not support these outcomes puts us on a course that is fundamentally different to the rest of the world. Before doing this we need to be very sure the US and UK and wrong and NEHTA/DoHA is right!